Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CULTURE, NOSE

Facility

$390.00

Service Code	HCPCS 87070
Hospital Charge Code	3008877
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CULTURE, NOSE

Facility

$390.00

Service Code	HCPCS 87070
Hospital Charge Code	3008877
Hospital Revenue Code	306
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$23.45
Rate for Payer: Aetna Medicare Advantage	$27.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.27
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$8.62
Rate for Payer: Clover Medicare Advantage	$8.19
Rate for Payer: EmblemHealth Commercial	$25.86
Rate for Payer: Humana Medicare Advantage	$8.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$6.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.62
Rate for Payer: Wellcare Medicare Advantage	$8.62
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

CULTURE, OTHER SOURCE

Facility

$349.00

Service Code	HCPCS 87070
Hospital Charge Code	38475026
Hospital Revenue Code	306
Min. Negotiated Rate	$52.35
Max. Negotiated Rate	$52.35
Rate for Payer: Qualcare PPO/HMO/WC	$52.35

CULTURE, OTHER SOURCE

Facility

$349.00

Service Code	HCPCS 87070
Hospital Charge Code	38475026
Hospital Revenue Code	306
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$174.50
Rate for Payer: Aetna Commercial	$23.45
Rate for Payer: Aetna Medicare Advantage	$27.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.27
Rate for Payer: Cigna Commercial	$174.50
Rate for Payer: Cigna Medicare Advantage	$8.62
Rate for Payer: Clover Medicare Advantage	$8.19
Rate for Payer: EmblemHealth Commercial	$25.86
Rate for Payer: Humana Medicare Advantage	$8.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.74
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.35
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$6.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.62
Rate for Payer: Wellcare Medicare Advantage	$8.62
Rate for Payer: Wellpoint Medicaid Managed Care	$9.91

CULTURE, OTHER SOURCES

Facility

$390.00

Service Code	HCPCS 87070
Hospital Charge Code	3000080
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CULTURE, OTHER SOURCES

Facility

$390.00

Service Code	HCPCS 87070
Hospital Charge Code	3000080
Hospital Revenue Code	306
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$23.45
Rate for Payer: Aetna Medicare Advantage	$27.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.27
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$8.62
Rate for Payer: Clover Medicare Advantage	$8.19
Rate for Payer: EmblemHealth Commercial	$25.86
Rate for Payer: Humana Medicare Advantage	$8.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$6.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.62
Rate for Payer: Wellcare Medicare Advantage	$8.62
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

CULTURE OTHER SPEC AEROBIC-SO

Facility

$149.72

Service Code	HCPCS 87070
Hospital Charge Code	40134556A
Hospital Revenue Code	306
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$23.45
Rate for Payer: Aetna Medicare Advantage	$27.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.27
Rate for Payer: Cigna Commercial	$74.86
Rate for Payer: Cigna Medicare Advantage	$8.62
Rate for Payer: Clover Medicare Advantage	$8.19
Rate for Payer: EmblemHealth Commercial	$25.86
Rate for Payer: Humana Medicare Advantage	$8.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.93
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.46
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$6.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.62
Rate for Payer: Wellcare Medicare Advantage	$8.62
Rate for Payer: Wellpoint Medicaid Managed Care	$4.25

CULTURE OTHER SPEC AEROBIC-SO

Facility

$149.72

Service Code	HCPCS 87070
Hospital Charge Code	40134556A
Hospital Revenue Code	306
Min. Negotiated Rate	$22.46
Max. Negotiated Rate	$22.46
Rate for Payer: Qualcare PPO/HMO/WC	$22.46

CULTURE OTHR SPEC AEROBIC-SO

Facility

$94.65

Service Code	HCPCS 87070
Hospital Charge Code	4013388A
Hospital Revenue Code	306
Min. Negotiated Rate	$14.20
Max. Negotiated Rate	$14.20
Rate for Payer: Qualcare PPO/HMO/WC	$14.20

CULTURE OTHR SPEC AEROBIC-SO

Facility

$63.93

Service Code	HCPCS 87070
Hospital Charge Code	40134446A
Hospital Revenue Code	306
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$23.45
Rate for Payer: Aetna Medicare Advantage	$27.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.27
Rate for Payer: Cigna Commercial	$31.96
Rate for Payer: Cigna Medicare Advantage	$8.62
Rate for Payer: Clover Medicare Advantage	$8.19
Rate for Payer: EmblemHealth Commercial	$25.86
Rate for Payer: Humana Medicare Advantage	$8.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.62
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.59
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$6.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.62
Rate for Payer: Wellcare Medicare Advantage	$8.62
Rate for Payer: Wellpoint Medicaid Managed Care	$1.82

CULTURE OTHR SPEC AEROBIC-SO

Facility

$63.93

Service Code	HCPCS 87070
Hospital Charge Code	40134446A
Hospital Revenue Code	306
Min. Negotiated Rate	$9.59
Max. Negotiated Rate	$9.59
Rate for Payer: Qualcare PPO/HMO/WC	$9.59

CULTURE OTHR SPEC AEROBIC-SO

Facility

$94.65

Service Code	HCPCS 87070
Hospital Charge Code	4013388A
Hospital Revenue Code	306
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$23.45
Rate for Payer: Aetna Medicare Advantage	$27.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.27
Rate for Payer: Cigna Commercial	$47.33
Rate for Payer: Cigna Medicare Advantage	$8.62
Rate for Payer: Clover Medicare Advantage	$8.19
Rate for Payer: EmblemHealth Commercial	$25.86
Rate for Payer: Humana Medicare Advantage	$8.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.61
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.20
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$6.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.62
Rate for Payer: Wellcare Medicare Advantage	$8.62
Rate for Payer: Wellpoint Medicaid Managed Care	$2.69

Culture, Salmonella & Shigella

Facility

$58.16

Service Code	HCPCS 10019
Hospital Charge Code	3000074
Hospital Revenue Code	306
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$22.10
Rate for Payer: Aetna Medicare Advantage	$17.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.83
Rate for Payer: Cigna Commercial	$29.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.12
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.72
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$1.84
Rate for Payer: Wellpoint Medicaid Managed Care	$1.65

Culture, Salmonella & Shigella

Facility

$58.16

Service Code	HCPCS 10019
Hospital Charge Code	3000074
Hospital Revenue Code	306
Min. Negotiated Rate	$8.72
Max. Negotiated Rate	$8.72
Rate for Payer: Qualcare PPO/HMO/WC	$8.72

CULTURE SALMONELLA/SHIGELLA

Facility

$390.00

Service Code	HCPCS 87046
Hospital Charge Code	401187046A
Hospital Revenue Code	306
Min. Negotiated Rate	$7.55
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$25.68
Rate for Payer: Aetna Medicare Advantage	$30.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.24
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$9.44
Rate for Payer: Clover Medicare Advantage	$8.97
Rate for Payer: EmblemHealth Commercial	$28.32
Rate for Payer: Humana Medicare Advantage	$9.72
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$7.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.44
Rate for Payer: Wellcare Medicare Advantage	$9.44
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

CULTURE SALMONELLA/SHIGELLA

Facility

$390.00

Service Code	HCPCS 87046
Hospital Charge Code	401187046A
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CULTURE SCREEN METHICILLIN RES

Facility

$104.49

Service Code	HCPCS 87081
Hospital Charge Code	401387076
Hospital Revenue Code	306
Min. Negotiated Rate	$2.97
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$18.03
Rate for Payer: Aetna Medicare Advantage	$21.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.05
Rate for Payer: Cigna Commercial	$52.24
Rate for Payer: Cigna Medicare Advantage	$6.63
Rate for Payer: Clover Medicare Advantage	$6.30
Rate for Payer: EmblemHealth Commercial	$19.89
Rate for Payer: Humana Medicare Advantage	$6.83
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.17
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.67
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$5.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.63
Rate for Payer: Wellcare Medicare Advantage	$6.63
Rate for Payer: Wellpoint Medicaid Managed Care	$2.97

CULTURE SCREEN METHICILLIN RES

Facility

$104.49

Service Code	HCPCS 87081
Hospital Charge Code	401387076
Hospital Revenue Code	306
Min. Negotiated Rate	$15.67
Max. Negotiated Rate	$15.67
Rate for Payer: Qualcare PPO/HMO/WC	$15.67

CULTURE, SPUTUM

Facility

$770.30

Service Code	HCPCS 87070
Hospital Charge Code	3000098
Hospital Revenue Code	306
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$385.15
Rate for Payer: Aetna Commercial	$23.45
Rate for Payer: Aetna Medicare Advantage	$27.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.27
Rate for Payer: Cigna Commercial	$385.15
Rate for Payer: Cigna Medicare Advantage	$8.62
Rate for Payer: Clover Medicare Advantage	$8.19
Rate for Payer: EmblemHealth Commercial	$25.86
Rate for Payer: Humana Medicare Advantage	$8.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$115.55
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$6.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.62
Rate for Payer: Wellcare Medicare Advantage	$8.62
Rate for Payer: Wellpoint Medicaid Managed Care	$21.88

CULTURE, SPUTUM

Facility

$770.30

Service Code	HCPCS 87070
Hospital Charge Code	3000098
Hospital Revenue Code	306
Min. Negotiated Rate	$115.55
Max. Negotiated Rate	$115.55
Rate for Payer: Qualcare PPO/HMO/WC	$115.55

CULTURE, STOOL

Facility

$869.58

Service Code	HCPCS 87045
Hospital Charge Code	3003274
Hospital Revenue Code	309
Min. Negotiated Rate	$7.55
Max. Negotiated Rate	$434.79
Rate for Payer: Aetna Commercial	$25.68
Rate for Payer: Aetna Medicare Advantage	$30.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.24
Rate for Payer: Cigna Commercial	$434.79
Rate for Payer: Cigna Medicare Advantage	$9.44
Rate for Payer: Clover Medicare Advantage	$8.97
Rate for Payer: EmblemHealth Commercial	$28.32
Rate for Payer: Humana Medicare Advantage	$9.72
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$226.09
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$130.44
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$7.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.44
Rate for Payer: Wellcare Medicare Advantage	$9.44
Rate for Payer: Wellpoint Medicaid Managed Care	$24.70

CULTURE, STOOL

Facility

$869.58

Service Code	HCPCS 87045
Hospital Charge Code	3003274
Hospital Revenue Code	309
Min. Negotiated Rate	$130.44
Max. Negotiated Rate	$130.44
Rate for Payer: Qualcare PPO/HMO/WC	$130.44

CULTURE STREPTOCOCCUS GRP B-SO

Facility

$176.95

Service Code	HCPCS 87081
Hospital Charge Code	401315090
Hospital Revenue Code	306
Min. Negotiated Rate	$5.03
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$18.03
Rate for Payer: Aetna Medicare Advantage	$21.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.05
Rate for Payer: Cigna Commercial	$88.47
Rate for Payer: Cigna Medicare Advantage	$6.63
Rate for Payer: Clover Medicare Advantage	$6.30
Rate for Payer: EmblemHealth Commercial	$19.89
Rate for Payer: Humana Medicare Advantage	$6.83
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.01
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.54
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$5.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.63
Rate for Payer: Wellcare Medicare Advantage	$6.63
Rate for Payer: Wellpoint Medicaid Managed Care	$5.03

CULTURE STREPTOCOCCUS GRP B-SO

Facility

$176.95

Service Code	HCPCS 87081
Hospital Charge Code	401315090
Hospital Revenue Code	306
Min. Negotiated Rate	$26.54
Max. Negotiated Rate	$26.54
Rate for Payer: Qualcare PPO/HMO/WC	$26.54

CULTURE, THROAT

Facility

$601.42

Service Code	HCPCS 87070
Hospital Charge Code	3009479
Hospital Revenue Code	306
Min. Negotiated Rate	$90.21
Max. Negotiated Rate	$90.21
Rate for Payer: Qualcare PPO/HMO/WC	$90.21

Know your out-of-pocket cost for care.

All Charges